If You Have Questions, Concerns or CommentsAt Inova, we recognize the importance of effective communication between you and our dedicated healthcare team. We encourage you to ask questions and share concerns while you are in the hospital so that those who are caring for you can provide prompt, courteous solutions to any issues that may arise.

Additionally, the hospital’s patient representatives are available to help patients and families with problems, clarify hospital policies, and assist with disability access issues or other special needs. The Patient Relations program has a process to address all complaints and grievances. Patient representatives welcome the opportunity to assist you, and can be reached at the phone numbers listed below.

Patient Representative Contact NumbersInova Alexandria Hospital. . . . . . . . . . . . .703.504.3128

Inova Fairfax Medical Campus. . . . . . . . 703.776.3663

- Inova Fairfax Hospital- Inova Children’s Hospital- Inova Heart and Vascular Institute

- Inova Women’s Hospital

Inova Fair Oaks Hospital. . . . . . . . . . . . 703.391.3607 or 703.391.3885

Inova Loudoun Hospital. . . . . . . . . . . . . . 703.858.6795

Inova Mount Vernon Hospital. . . . . . . . . 703.664.7555

We hope you will allow us the opportunity to assist with any issues that may arise during your hospital stay. If you choose, you may also contact the Virginia Department of Health, Office of Licensure and Certification, 9960 Mayland Drive, Suite 401, Richmond, VA 23233, or call 800.955.1819.

Additionally, you may contact the Office of Quality Monitoring, The Joint Commission, One Renaissance Blvd., Oakbrook Terrace, IL 60181, or call 800.994.6610.

Insurance ConcernsIf you have questions or concerns about decisions made by your health insurance plan, contact the Managed Care Ombudsman at 877.310.6560.

Ethics ConsultationOur hospitals’ Ethics Committees provide consultation services to help a patient or family deal with questions of life and death, as well as the quality of life. The Ethics Consultation team helps patients, families, physicians and hospital staff talk about appropriate plans of care when an ethical dilemma exists. The role of the team is to advise; it does not judge or make decisions. Its assistance is intended to help clarify issues for the patient and family members involved, and give them the information they need to make decisions.

Anyone directly involved with a patient can seek a consultation on the patient’s behalf, including the patient, family members, friends, physicians, nurses, as well as other members of the patient’s care team.

To contact a member of our hospital’s Ethics Consultation team, call the hospital operator or the hospital’s patient representative.

inova.org/patientrightsG34328/9-15/200

Your Healthcare DecisionsYou have the right to complete an Advance Directive which shares your wishes if you are unable to make healthcare decisions for yourself. An Advance Directive can include:

Designating someone to make healthcare decisions for you and the types of decisions they can make

Specific healthcare decisions to include end-of-life decisions

Organ donation decision

It is our policy to respect your wishes in accordance with the law and the hospital’s capabilities. If your attending or treating physician has a personal conscience-based objection to the stated wishes in your Advance Directive (for example, reproductive or end-of-life decisions), under Virginia Code 54.1-2987 and Inova policy, the physician must make a reasonable effort to transfer your care to another physician willing to comply with your wishes.

If you have an Advance Directive, please provide us with a copy. If you would like more information on Advance Directives, please ask your nurse or patient representative.

Your Guide to Patient Rights and Responsibilities

Receive visitors designated by the patient, including but not limited to, a spouse, a domestic partner (including same-sex domestic partner), another family member or a friend. Also included is the right to withdraw or deny such consent at any time.

Be informed of the hospital’s practice that allows for the presence of a support individual unless it interferes with the rights of others, or is not recommended for medical reasons

Have a family member or representative, and your physician, notified of your admission

Prepare an advance directive to make certain your healthcare choices are followed if you are unable to communicate those choices to us

Receive care in a safe setting, free of all forms of abuse or harassment

A hospital setting that preserves dignity and contributes to a positive self-image

Respect for your cultural and personal values, beliefs, and preferences, as well as an opportunity to take part in religious and other spiritual services

Contact protective and advocacy services

Expect that the hospital will protect your confidentiality and respect your privacy

See your medical record; request amendments to your medical record; and request a list of persons or organizations to whom your health information was disclosed as determined by federal or state law

Give permission to the recording or filming made for purposes other than identification, diagnosis or treatment. You also have the right to cancel this agreement.

Agree or refuse to participate in research studies

File a complaint and not be subject to discrimination, force, punishment or unreasonable interruption of care, treatment or services

Have your hospital bill explained and receive information about financial help

Patient ResponsibilitiesAs a patient, you are responsible for the following:

Providing complete and accurate information about your health, including past illnesses, hospital stays, use of medications and other matters relating to your health

Asking questions when you do not understand what you have been told about your care or what you are expected to do

Following the care, service or treatment plan developed for you

Telling your doctor if you believe you cannot follow through with your treatment plan and understanding the possible results if you decide not to follow the recommended treatment plan

Providing the hospital with accurate contact and billing information

Detailed knowledge of your health insurance coverage including deductibles, co-pays and network coverage

Being considerate of other patients, staff and hospital property and following hospital rules and regulations. This applies to your visitors as well.

Providing necessary information for insurance claims and to pay your bills or make arrangements for financial obligations in a timely manner

Recognizing that the hospital cannot accept responsibility for any personal property not deposited in the hospital safe

Rights of the DisabledWhen serving the disabled, our hospital continually strives to meet the objectives of the Americans with Disabilities Act (ADA) and the Virginians with Disabilities Act. If you encounter any physical or communication barrier during your time at our hospital, or if you believe you have been denied access to the hospital’s full array of services because of your disability, please contact the Compliance Department at 703.205.2337 or the patient representative.

Services for the Deaf and Hard of Hearing

To ensure effective communication with patients, their family members, and companions who are deaf or hard of hearing, we provide auxiliary aids and services free of charge, such as:

Sign language and oral interpreters

Telecommunications typewriters for the deaf or hearing impaired (TTY/TDD)

Video remote interpreting (VRI)

Written materials

Telephone handset amplifiers

Assistive listening devices (marketed as a Pocketalker or Posey sound amplifier)

Telephones compatible with hearing aids

Open and closed captioning of most hospital television programs

Please ask your nurse or other hospital personnel for assistance, or contact 703.776.7641.

Patient Rights and ResponsibilitiesWe can provide better healthcare services when you and your family work together as partners with our staff and physicians. It is our responsibility to advise you of your rights as a patient; you also have responsibilities in your treatment and care. We urge you to ask questions, be proactive and take an active part in your care plan. If you have questions or concerns, please discuss these with your doctor, any staff member or contact the hospital’s patient representative.

Overview of Patient RightsWhile you are in our hospital, you have certain rights as a patient. You have the right to:

Receive treatment regardless of your age, gender, race, national origin, language, religion, sexual orientation, disability or any other discrimination prohibited by law

Know the names and titles of your healthcare team members

Receive information in a language or manner you understand. This includes the right to interpreter services at no cost to you.

Be informed about possible results of care, treatment and services, including unexpected results

Be informed and involved in making healthcare decisions

Agree to or refuse care, treatment and services

Appropriate evaluation and management of pain

Courteous and respectful care

Be free from restraints of any form that are not medically necessary